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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530256
Report Date: 01/07/2025
Date Signed: 01/07/2025 02:40:20 PM

Document Has Been Signed on 01/07/2025 02:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:HILLTOP GUEST HOME 2FACILITY NUMBER:
335530256
ADMINISTRATOR/
DIRECTOR:		BUNDALIAN, CHRISTOPHER AFACILITY TYPE:
740
ADDRESS:21710 PINK GINGER COURTTELEPHONE:
(562) 397-3192
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY: 5CENSUS: 0DATE:
01/07/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Administrator Christopher BundalianTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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On 01/07/2025, at 12:20 PM, Licensing Program Analyst (LPA) Melody Brown conducted an announced visit to the facility for the purpose of a Prelicensing Visit. LPA Brown met with Administrator Christopher Bundalian. An initial application for license to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 10/27/2024 for a total capacity of five (5). Fire clearance was granted on 07/22/2024 for four (4) non-ambulatory residents and one (1) bedridden. LPA Brown observed the following:

Structure:
Facility was a one (1) level house with four (4) bedrooms for residents, one (1) bedroom for staff, three (3) resident/staff bathrooms, living room, dining area, laundry room and kitchen. There is an attached two (2) car garage.
Heating/Cooling System:
Central heating and air conditioning system installed with a central panel located in the hallway to control the entire house.
Bedrooms:
Each resident bedrooms accommodate any non-ambulatory resident, and bedroom #5 was approved for bedridden resident. All resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm.
Bathrooms:
The three staff/resident bathrooms have a working toilet, wash basin, and tub & shower with non-slip mat with an adequate supply of toilet paper and soap. At 12:50 PM, LPA Brown tested the water temperatures in the resident/staff shared bathrooms. LPA verified water temperature was measured at 105.6 degrees Fahrenheit. ***CONTINUED ON LIC 809C***
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: HILLTOP GUEST HOME 2
FACILITY NUMBER: 335530256
VISIT DATE: 01/07/2025
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***CONTINUED FROM LIC 809***
Kitchen/Laundry:
An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There's adequate room for food storage. LPA Brown observed the stove to be operational. Refrigerator/freezer were in working condition. More than two (2) days supply of perishable foods and more than seven (7) days supply of non-perishable foods noted. There's an adequate seating for meals for all residents. Laundry room with washer and dryer was also observed. Laundry detergents and cleaning supplies are stored in the laundry room.
Living/Family room:
There's a living/family room with adequate seating for all residents and a working TV.

Linens and Hygiene Supplies: An adequate supply of linens was stored in each resident bedrooms.
Yards/Outside:
Patio furniture for outdoor seating observed. Gate on the right side of the facility that leads into the backyard. All outdoor pathways were free of obstructions.
Emergency Phone Numbers, and Exit Plan:
Facility sketch was observed posted in the hallway and all resident rooms. Ombudsman poster, Let-Us-No poster, Personal Rights, House Rules, Visitation Policy, Rights of Resident Councils, Rights of Family Councils, Emergency Disaster Plan were noted posted in a common area.
Dementia Care Plan:
Dementia Care Plan was observed and reviewed during the visit today, 01/072025.
General items:
Two (2) fire extinguishers were charged and located throughout the facility. Eight (8) smoke alarms and one (1) carbon monoxide detector were tested and were observed to be in working order. Resident and staff records will be stored in a locked cabinet in the office room. First Aid kit with required components and first aid book, and locked area for medication storage was observed. LPA observed a facility phone and was operational as evidenced by LPA dialing the number. The phone number designated for the facility is 951-579-1271. ***CONTINUED ON LIC 809C***
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: HILLTOP GUEST HOME 2
FACILITY NUMBER: 335530256
VISIT DATE: 01/07/2025
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***CONTINUED FROM LIC 809C**
There is enough Emergency water supply observed and the required 72-hour emergency food supply was observed from the regular food supply. Component III was completed on this day as well. Additionally, LPA Brown observed facility having the required single entry point with Sign In/Sign Out Sheet for Visitors and Residents, upon entering the facility. LPA Brown observed activities for the residents such as books and games and planned menu.

The facility was evaluated in accordance with the California Code of Regulation (CCR), Title 22 Division 6 Chapter 8 to ensure the health and safety of residents in care. Facility appears to be ready for licensure.

An exit interview was conducted, and a copy of this report, LIC809 was discussed and provided to Administrator Christopher Bundalian.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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